POP + Urinary Incontinence Flashcards
what can lead to prolapse? (3)
pregnancy/labor/delivery
increased intra-abdominal pressure
atrophy
what are the 3 associated cystocele symptoms of prolapse?
heaviness
sensation of bulge
pelvic fullness
what worsens cystocele symptoms?
prolonged standing
what makes cystocele symptoms better?
lying down
usually presents as asymptomatic but can present with low back/sacral pain, perineal pressure, palpable bulge, and rapid progression
enterocele
presents with perineal pressure, obstructive defection that requires digital reduction, loose genitals, and palpable bulge
rectocele
which type of prolapse is considered anterior?
cystocele
which 2 types of prolapse is considered apical?
uterine
vaginal vault
which 2 types of prolapse are considered posterior?
rectocele
enterocele
procidentia
complete uterine prolapse
what are the 2 systems used to quantify amount of prolapse?
baden-walker system
Pelvic Organ Prolapse - Quantification
stage is based on position of _____ ___ relative to _____
vaginal walls
hymen
what are 5 treatment options for prolapse?
observation
estrogen
kegels/pelvic floor exercises
pessaries
surgery
the cardinal ligaments that blend with the utero-sacral ligaments; they attach the upper vagina, cervix, and lower uterine segment to the sacrum and lateral pelvic side walls
level 1
the paravaginal attachments found at the level of the ischial spines; function to keep the vagina in the middle, directly over the rectum
level 2
provided by the perineal body and membrane, superficial and deep perineal muscles, and endopelvic fascia; support and maintain the normal position of the distal 1/3 of the vagina and introitus (opening)
level 3
what is the gold standard treatment for level 1 of the vaginal apex?
sacrocolpopexy
uses surgical mesh to lift organs back into place
treatment for level 2 anterior compartment?
anterior colporrhaphy
strengthens vaginal wall muscles and tissues
what is the treatment for level 3 posterior compartment?
posterior colporrhaphy
vaginal wall repair
AKA vaginal closure; only used in women who no longer desire sexual activity
colpocleisis
patient prefers non-surgical treatment, and US shows endometrial stripe of 2mm. Bleeding is most likely from cervix rubbing on underwear. treatment?
estrogen cream
fit patient for pessary
urinary incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency
stress incontinence
urinary incontinence due to detrusor spasms
urge incontinence
some element of urinary retention and urine simply drips out when the bladder is over full
overflow incontinence
what part of the evaluation is the most important when evaluating a patient for incontinence?
history
45 yo patient G3P3 presents with urinary leakage and has noticed this since the birth of her last child 5 years ago. She has PMHx of asthma, PSxHx of cholecystectomy and tubal ligation. She has mixed incontinence by history and her urinalysis is negative. You see leakage when she coughs and she voids 300cc with a post-void residual of 15cc. what is her likely dx?
overactive bladder
what are 4 conservative treatment options for overactive bladder?
bladder retraining
behavior modification
fluid management
pelvic floor exercises
what are 2 pharmacological treatment options for overactive bladder?
anti-muscarinic
B3 agonists (Mirabegron)
what are 3 procedure treatment options for overactive bladder?
percutaneous tibial nerve stimulation
interstim neuromodulator
botox
what are 3 conservative treatment options for stress UI?
biofeedback
pelvic floor exercises
pessary
what are 2 pharmacological treatment options for stress UI?
vaginal estrogen
tricyclic antidepressants (imipramine)
what are 3 procedure treatment options for stress UI?
urethral bulking to tighten urethra
burch urethropexy (suspension)
midurethral slings
